The main symptom of Achilles tendinopathy is pain, usually at the back of your ankle. You may also have some stiffness. The pain is usually worse first thing in the morning, or after you have been inactive for a period of time. Achilles tendinopathy may interfere with your day-to-day life.
At first you might have pain when you start and after you finish exercise, but the pain goes away when you’re exercising. Over time, as the injury gets worse, you may also have pain while you exercise and it may become constant. You may also have some swelling and your Achilles tendon might feel tender when you touch it.
If you have any of these symptoms, visit a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility). Alternatively your GP may be able to refer you to a physiotherapist.
If you have sudden pain in your heel or calf, and it becomes swollen, bruised and painful, you may have completely torn your Achilles tendon. If this happens, you must seek urgent medical attention.
Your GP or physiotherapist will ask you about your symptoms and examine you. He or she may also ask you about your medical history.
Your GP or physiotherapist may ask you to do a series of movements or exercises to see how well you can move your leg. He or she may also examine your leg, heel and ankle and may squeeze your calf muscle to check the movement of your foot.
You may need to have further tests to confirm if there are tears in your Achilles tendon, which may include the following.
- An ultrasound scan. This uses sound waves to produce an image of the inside of your leg.
- An MRI scan. This uses magnets and radio waves to produce images of the inside of your leg.
Your GP or physiotherapist may refer you to see an orthopaedic surgeon (a doctor who specialises in bone surgery), or a sports medicine specialist.
The type of treatment you may need for Achilles tendinopathy will depend on how serious your injury is. Your symptoms may take between three and six months to get better (see our frequently asked questions for more information).
There are a number of things you can do to help Achilles tendinopathy. The main ones are listed below.
- Reduce the amount of exercise you’re doing and how often you exercise. This will help to rest your tendon.
- Wear a small heel raise in each shoe. This will help to reduce the stress on your Achilles tendon.
- Wear well-padded and supportive shoes.
- Run or exercise on a soft running surface.
- Stretch your Achilles tendon every day.
If the pain or swelling is bad, you can ice the back of your ankle to reduce swelling and bruising. Use an ice pack or ice wrapped in a towel. Don’t apply ice directly to your skin as it can damage it.
If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Your doctor may also prescribe you glyceryl trinitrate patches to put on the skin on your heel to reduce pain from Achilles tendinopathy.
Your GP may refer you to a physiotherapist, or you can arrange an appointment with a physiotherapist directly yourself.
Physiotherapy will aim to strengthen and stretch your Achilles tendon. Your physiotherapist will give you a programme that will include stretching exercises and heel-lowering exercises on a step (referred to as eccentric loading). You may need to do these exercises every day.
Your physiotherapist may use other techniques to help reduce your pain and speed up the healing of your Achilles tendon, such as massage.
If your Achilles tendinopathy doesn’t get better with other treatments, your doctor may recommend that you have extracorporeal shockwave therapy. In this treatment, your doctor will use a machine to pass high energy shockwaves through your skin to the affected area of your tendon. It’s a relatively new treatment and doctors still don’t know how well it works. Ask your doctor for more information.
There are other specialist treatments that your physiotherapist or sports medicine specialist might recommend too. These include:
- blood or platelet-rich plasma (PRP) injections, which are thought to help your Achilles tendon heal faster
- high-volume injections of saline, which are thought to help ease the pain from Achilles tendinopathy
However, these treatments aren’t widely available and are only used by expert specialists because there isn’t much good evidence to show they work. Ask your physiotherapist or sports medicine specialist for more information.
Your doctor may recommend surgery if, after around six months, other treatments haven’t worked and your symptoms are having an impact on your day-to-day life.
Surgery involves removing damaged areas of your tendon and repairing them.
Achilles tendinopathy is a common injury in runners and people who play sports that involve running.
It’s usually caused by overusing your Achilles tendon. As you get older, your Achilles tendon becomes less flexible and less able to cope with the stress that running puts on it. Very small tears can start to develop and if you carry on running, the tears won’t heal and your tendon can become weaker. Sometimes your Achilles tendon can tear completely and this is called Achilles tendon rupture.
Achilles tendinopathy is more likely to develop if you:
- have a family history of the condition
- have a health condition such as diabetes or high blood pressure
- take a type of antibiotic medicine called quinolone
- have a high or low arched foot
- start a new physical activity, or increase your intensity of exercise – for example, how far and how fast you run
- train on hard, slippery or slanting surfaces
- change the shoes you wear, or wear the wrong type of shoes
- have a poor running technique, for example, you roll your feet inwards as you run, which is called overpronation
- wear high heels frequently
- have your saddle set too low when you cycle
There are a number of things you can do to help prevent Achilles tendinopathy. The main ones are listed below.
- Wear appropriate and well-fitting shoes when you exercise.
- When you start a new exercise regime, gradually increase the intensity and the length of time you spend being active.
- Warm up your muscles before you exercise and cool them down after you have finished. The benefit of stretching before or after exercise is unproven. However, it may help to stretch your calf muscles, which will help to lengthen your Achilles tendon, before you exercise.
- If the shape of your foot increases the stress on your Achilles tendon, wear an insole in your shoe. You can buy these off-the-shelf or they can be custom-made for you. Ask your physiotherapist for advice.
How long will Achilles tendinopathy take to heal?
Once you get treatment, it can take between three and six months for the symptoms of Achilles tendinopathy to get better. If it doesn’t heal after this time, you may need to consider having surgery.
Your symptoms should get better three to six months after you start treatment. If they don’t, your GP may refer you to see an orthopaedic surgeon or sports medicine doctor. Surgery may be an option but it's usually a last resort after you have tried other types of treatment.
The sooner you're diagnosed with Achilles tendinopathy and start your treatment, the more effective it will be. If you do too much exercise while you’re having treatment, it may delay your recovery.
Will I be able to return to activity after treatment for Achilles tendinopathy?
Most people with Achilles tendinopathy will be able to return to running and playing sport after treatment. However, it's important that you return to physical activity gradually.
If you need an operation to repair your tendon, you may not be able to return to the level of activity you were doing before. This is because the tendon may not be strong or flexible enough for you to run and play sport.
When you go back to running or playing sport there are a number of things you can do to reduce the risk of further injury. The main ones are listed below.
- If your Achilles tendinopathy was caused by an underlying problem, it’s important to correct this before you start activity again. For example, if you roll your feet inwards as you run, you may need to wear insoles in your shoes. Or you may need to visit a podiatrist (a health professional who specialises in conditions that affect the feet) to have your gait analysed. Your gait is the way you walk.
- Prepare a training programme and start any new activity slowly and gradually build up your activity levels. Make sure you have rest days. If your symptoms don’t return, you can build up to more intensive activity.
- Stretch after any activity and continue with any muscle strengthening exercises you have been given by your physiotherapist.
What type of shoe should I be wearing?
Wearing the right type of shoe for the activity you’re doing can help to prevent Achilles tendinopathy from developing or coming back after an injury. Wearing insoles or heel lifts in your shoes can help to reduce pain from Achilles tendinopathy.
Running or playing sports can put a lot of strain on your feet and your Achilles tendon, so it’s important to wear the right shoes.
The type of shoe that you need will depend on things like how you run and the kind of activity you’re doing. For example, shoes for running should be flexible so that your feet can bend and flex through each step. Shoes for racquet sports, in contrast, need to be stiffer. Go to a good sports or running shop and have your feet properly fitted for the shoes you need for your sport.
Wearing high heels can put strain on your Achilles tendon. Try not to wear high heels often and stretch your calf muscles regularly.
If you have Achilles tendinopathy, you may be able to reduce any pain by wearing insoles or heel lifts in your shoes. Custom-made insoles can help to correct the shape of your feet and put less strain on your Achilles tendon. Your GP or physiotherapist can refer you to podiatrist to have these made. Heel lifts raise your feet by a small amount. This takes some strain off the tendon and moves your heel away from the back of your shoe, where rubbing can occur.
Shoes that are softer at the back of the heel can reduce irritation of your Achilles tendon and help to reduce your pain. It’s also important to regularly stretch your Achilles tendon every day.
- Asplund CA, Best TM. Achilles tendon disorders. BMJ 2013; 346:f1262. doi:org/10.1136/bmj.f1262
- Achilles tendinopathy. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published April 2010
- Achilles tendon. British Orthopaedic Foot and Ankle Society. www.bofas.org.uk, published 27 February 2014
- Carcia CR, Martin RL, Houck J, et al. Orthopaedic section of the American Physical Therapy Association. Achilles pain, stiffness, and muscle power deficits: achilles tendinitis. J Orthop Sports Phys Ther 2010; 40(9):A1–26. www.guideline.gov
- Achilles tendonitis and rupture. PatientPlus. www.patient.co.uk/patientplus.asp, published 7 June 2013
- Achilles tendinitis. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published June 2010
- Achilles tendonitis. Medscape. www.emedicine.medscape.com, published 19 July 2013
- Platelet-rich plasma injection for achilles tendinopathy. California Technology Assessment Forum. www.ctaf.org, published 13 October 2010
- Weinfeld SB. Achilles tendon disorders. Med Clin N Am 2014; 98(2):331–38. doi:10.1016/j.mcna.2013.11.005
- Wilson F, Bleakley C, Bennett K, et al. Exercise, orthoses and splinting for treating Achilles tendinopathy (protocol). Cochrane Database of Systematic Reviews 2013, Issue 12. doi:10.1002/14651858.CD010874
- Extracorporeal shockwave therapy for refractory Achilles tendinopathy. National Institute for Health and Care Excellence (NICE), August 2009. www.nice.org.uk
- Maffulli N, Spiezia F, Longo UG, et al. High volume image guided injections for the management of chronic tendinopathy of the main body of the Achilles tendon. Phys Ther Sport 2013; 14(3):163–67. doi:10.1016/j.ptsp.2012.07.002
- Herbert RD, de Noronha M, Kamper SJ. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database of Systematic Reviews 2011, Issue 7. doi:10.1002/14651858.CD004577.pub3
- Abnormal gait. PatientPlus. www.patient.co.uk/patientplus.asp, published 17 September 2010
- Racquet sports. The College of Podiatry. www.scpod.org, accessed 6 March 2014
- Running. The College of Podiatry. www.scpod.org, accessed 6 March 2014
We’d love to know what you think about what you’ve just been reading and looking at – we’ll use it to improve our information. If you’d like to give us some feedback, our short form below will take just a few minutes to complete. And if there's a question you want to ask that hasn't been answered here, please submit it to us. Although we can't respond to specific questions directly, we’ll aim to include the answer to it when we next review this topic.
Let us know what you think using our short feedback form Ask us a question
Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, April 2014.
Let us know what you think using our short feedback form Ask us a question
About our health information
At Bupa we produce a wealth of free health information for you and your family. We believe that trustworthy information is essential in helping you make better decisions about your health and care. Here are just a few of the ways in which our core editorial principles have been recognised.
Information StandardWe are certified by the Information Standard. This quality mark identifies reliable, trustworthy producers and sources of health information.
What our readers say about us
But don't just take our word for it; here's some feedback from our readers.
“Simple and easy to use website - not alarming, just helpful.”
“It’s informative but not too detailed. I like that it’s factual and realistic about the conditions and the procedures involved. It’s also easy to navigate to areas that you specifically want without having to read all the information.”
“Good information, easy to find, trustworthy.”
Meet the team
Head of health content and clinical engagement
- Dylan Merkett – Lead Editor – UK Customer
- Nick Ridgman – Lead Editor – UK Health and Care Services
- Natalie Heaton – Specialist Editor – User Experience
- Pippa Coulter – Specialist Editor – Content Library
- Alice Rossiter – Specialist Editor – Insights
- Laura Blanks – Specialist Editor – Quality
- Michelle Harrison – Editorial Assistant
Our core principles
All our health content is produced in line with our core editorial principles – readable, reliable, relevant – which are represented by our diagram.
In a nutshell, our information is jargon-free, concise and accessible. We know our audience and we meet their health information needs, helping them to take the next step in their health and wellbeing journey.
We use the best quality and most up-to-date evidence to produce our information. Our process is transparent and validated by experts – both our users and medical specialists.
We know that our users want the right information at the right time, in the way that suits them. So we review our content at least every three years to keep it fresh. And we’re embracing new technology and social media so they can get it whenever and wherever they choose.
Here are just a few of the ways in which the quality of our information has been recognised.
The Information Standard certification scheme
You will see the Information Standard quality mark on our content. This is a certification programme, supported by NHS England, that was developed to ensure that public-facing health and care information is created to a set of best practice principles.
It uses only recognised evidence sources and presents the information in a clear and balanced way. The Information Standard quality mark is a quick and easy way for you to identify reliable and trustworthy producers and sources of information.
Certified by the Information Standard as a quality provider of health and social care information. Bupa shall hold responsibility for the accuracy of the information they publish and neither the Scheme Operator nor the Scheme Owner shall have any responsibility whatsoever for costs, losses or direct or indirect damages or costs arising from inaccuracy of information or omissions in information published on the website on behalf of Bupa.
British Medical Association (BMA) patient information awards
We have received a number of BMA awards for different assets over the years. Most recently, in 2013, we received a 'commended' award for our online shared decision making hub.
If you have any feedback on our health information, we would love to hear from you. Please contact us via email: firstname.lastname@example.org. Or you can write to us:
Health Content Team
15-19 Bloomsbury Way